Ligating instrument

ABSTRACT

A ligating instrument is provided, including an elongate member, such as a tube, having a lumen, the elongate member extending from a proximal actuator member to a distal ligating band dispenser. A pull line may extend through the lumen of the elongate member, with a proximal end of the pull line connected to the actuator member and a distal end of the pull line connected to the ligating band dispenser, wherein actuation of the actuator member draws the pull line in a proximal direction through the elongate member to deploy the ligating bands. The ligating band dispenser may be adapted to be mounted on the distal tip of an endoscope, and the elongate member may be adapted to be positioned outside of the endoscope from the ligating band dispenser to the actuator member. Alternatively, a ligating instrument may be provided for use with an endoscope, wherein a pull line of the ligating instrument is adapted to be positioned outside of the endoscope, wherein the pull line may be secured to the endoscope by clips or some other means. In a method of using a ligating instrument with an endoscope, a distal ligating band dispenser is attached to a distal tip of an endoscope, and a pull line of the ligating instrument is extended on the outside of the endoscope, such that the pull line extends, on the outside of the endoscope, from the distal ligating band dispenser to a proximal actuator member.

TECHNICAL FIELD

The present invention relates to medical ligating instruments and moreparticularly to medical ligating instruments that dispense ligatingbands.

BACKGROUND OF THE INVENTION

Ligation is a medical procedure whereby the physician ties off ormechanically constricts a piece of body tissue with an encirclingligature such as a suture, clip, or elastic band. The purpose ofligation is to impede or obstruct the flow of blood, fluids, and otherbodily materials through the tissue. For example, the physician canremove target tissue by ligating it to obstruct all circulation throughthe target tissue, thereby causing the tissue to die and slough off.

For ligating tissue inside a body cavity, orifice, or lumen, physiciansoften use an endoscope to access the target tissue and ligate it. In onesuch form of endoscopic ligation, the physician uses the endoscope toposition a stretched elastic band over the target tissue and thenrelease the band onto the tissue so that the band contracts and catchesthe tissue. The inward pressure of the elastic band constricts thetarget tissue.

Ligating instruments have been the subject of a number of patents,including U.S. Pat. No. 5,269,789 to Chin et al.; U.S. Pat. No.5,356,416 to Chu et al.; U.S. Pat. No. 5,398,844 to Zaslavsky et al.;U.S. Pat. No. 5,857,585 to Tolkoff et al.; U.S. Pat. No. 5,853,416 toTolkoff; U.S. Pat. No. 5,913,865 to Fortier et al.; U.S. Pat. No.6,235,040 to Chu et al.; and U.S. Pat. No. RE 36,629 to Zaslavsky et al.The disclosures of these prior U.S. patents are expressly incorporatedby reference herein.

A number of previous ligating instruments have relied on deployment ofthe elastic bands by a trigger wire or string that must be threadedthrough the lumen of an endoscope. Once the wire or string is threadedthrough the endoscope lumen, the user must then tie or otherwise connectthe free end of the wire or string to an actuator mechanism. The processof threading the wire or string and attaching it to the actuatormechanism adds additional steps in setting-up the instrument for use andcan be cumbersome. It can also lead to error and improper calibration ofthe device.

SUMMARY OF THE INVENTION

In accordance with certain embodiments of the invention, a ligatinginstrument for deploying ligating bands is provided, wherein theligating instrument comprises an elongate member, such as a tube, havinga lumen, the elongate member extending from a proximal actuator memberof the ligating instrument to a distal ligating band dispenser of theligating instrument. In accordance with such embodiments, a pull lineextends through the lumen of the elongate member, with a proximal end ofthe pull line connected to the actuator member and a distal end of thepull line connected to the ligating band dispenser, wherein actuation ofthe actuator member draws the pull line in a proximal direction throughthe elongate member to deploy the ligating bands.

A ligating instrument according to these embodiments may be designedsuch that the ligating band dispenser is adapted to be mounted on thedistal tip of an endoscope. The elongate member may be adapted to bepositioned outside of the endoscope from the ligating band dispenser tothe actuator member. The ligating instrument may include a sleeveadapted to be extended to secure at least a portion of the elongatemember relative to the outside of the endoscope. In certain embodiments,the sleeve may comprise the pull line and/or the elongate member.

In accordance with other embodiments of the invention, the ligatinginstrument may be free-standing such that it need not be connected to anendoscope.

In accordance with other embodiments of the invention, a ligatinginstrument may be provided for use with an endoscope, wherein a pullline of the ligating instrument is adapted to be positioned outside ofthe endoscope from a ligating band dispenser to an actuator member. Thepull line may be secured to the endoscope by clips or some other means.

In accordance with other embodiments of the invention, a method of usinga ligating instrument with an endoscope is provided. A distal ligatingband dispenser of the ligating instrument is attached to a distal tip ofan endoscope, and a pull line of the ligating instrument is extended onthe outside of the endoscope, such that the pull line extends, on theoutside of the endoscope, from the distal ligating band dispenser to aproximal actuator member. The ligating instrument may have an elongatemember having a lumen, such that the pull line extends through the lumenof the elongate member. The method may include the step of extending asleeve to secure at least a portion of the pull line or elongate memberrelative to the outside of the endoscope. The method may also includethe step of attaching the actuator member to the proximal end of theendoscope.

It will be appreciated that having a ligating instrument in which a pullline is not threaded through an endoscope lumen provides for simplifiedset-up. It will be appreciated that, in such embodiments, it may beprovided such that there is no need for the user to tie or otherwiseconnect a free end of the pull line to an actuator mechanism. Also, theligating device may be provided such that no additional calibration bythe user is required.

It will also be appreciated that, in certain embodiments of theinvention, the ligating instrument may be provided as a singlefunctional unit. It can be mounted on the endoscope as a singlefunctional unit or used independently. In addition, the distal ligatingband dispenser may be mounted on the distal end of an endoscope whilethe proximal actuator member is not mounted on the endoscope, allowingfor operation of the ligating instrument remote from and/or independentfrom the endoscope.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a side view of a ligating instrument in accordance with oneembodiment of the present invention.

FIG. 2 is a side view of the ligating instrument of FIG. 1 shownalongside an endoscope, with the distal ligating band dispenser and theproximal actuator assembly attached to the endoscope.

FIG. 3 is a cross-sectional view of the tubular member of FIG. 1.

FIG. 4 is a side view of the distal end of a ligating instrument inaccordance with one embodiment of the present invention.

FIG. 5 is a detailed cross-sectional view of the distal end of theligating instrument of FIG. 4.

FIG. 6 is a side view of the distal end of a ligating instrumentaccording to an alternate embodiment of the present invention, showing asleeve covering the distal portion of the instrument and endoscope.

FIG. 7 is a detailed side view of a ligating band dispenser inaccordance with one embodiment of the present invention.

DETAILED DESCRIPTION

A ligating instrument 10 in accordance with one possible embodiment ofthe present invention is illustrated in FIG. 1. At the distal end of theinstrument 10 is a ligating band dispenser 40 that dispenses ligatingbands 44. In this embodiment, the ligating band dispenser 40 is adaptedto be coupled to the distal tip of an endoscope 50 and includes aplurality of ligating bands 44 that are released by the drawing of apull line 32 in the form of a wire or string.

FIG. 7 shows one possible embodiment of the ligating band dispenser 40.This embodiment of the ligating band dispenser 40 includes a supportstructure 42, which may be substantially cylindrical. The ligating banddispenser may be designed to be attached to the distal end of anendoscope. For example, a central bore 46 (visible in FIG. 5) in theligating band dispenser 40 may be adapted to receive the distal tip ofan endoscope tube 54.

A plurality of ligating bands 44 are received around the supportstructure 42. In the embodiment illustrated in FIG. 7, the pull line 32wraps around each of the ligating bands 44, extends across the supportsurface 42 back and forth through a plurality of slots 43, and passesinto the central bore 46. The support surface 42 may be substantiallytransparent, at least at a distal portion.

In accordance with embodiments of the invention, the support structure42 may have an aperture 48 (shown in FIGS. 5 and 7) which allows thepull string to exit from the central bore 46 of the ligating banddispenser 40 to the outside of the endoscope tube 46. The aperture 48may be positioned such that it is located distal to the distal end ofthe endoscope when the ligating band dispenser 40 is attached to theendoscope.

As shown in FIGS. 4 and 5, an elongate member 30, which may be in theform of a tube, is coupled to the supporting structure 42 of theligating band dispenser 40. The pull line 32 extends inside the lumen 34(best shown in FIG. 3) of the elongate member 30. The pull line 32 canmove freely within the lumen 34 of the elongate member 30.

The elongate member 30 and pull line 32 extend alongside the endoscopetube 54 and accompany the endoscope 50 as it is inserted into a bodycavity, orifice, or lumen, such as the esophagus. In one embodiment, asshown in FIG. 6, an extendable sleeve 60 is provided at a distalposition on the elongate member 30, and the sleeve 60 can be extendedproximally to enclose the distal portions of the elongate member 30 andendoscope tube 54. This sleeve serves to join or secure the elongatemember 30, and thus the pull line 32, to the endoscope. This may aid ininsertion into a body cavity, orifice, or lumen. The sleeve 60 may bemade of elastomeric material and may be rolled so that it is extended byunrolling, as can be seen in FIG. 6.

In certain embodiments, the sleeve 60 may be adapted so that itcomprises the elongate member 30. For example, the elongate member 30may be incorporated into or affixed onto the sleeve 60. In someinstances, the joining of the elongate member 30 and the sleeve 60 mayform a single functional unit. In certain embodiments, the pull line 32may be incorporated into the sleeve 60 such that the ligating instrumentmay or may not have a separate elongate member through which the pullline 32 travels. For example, the pull line 32 may travel through achannel or pathway formed within the thickness of the sleeve 60.

The elongate member 30 is sufficiently long to allow the proximal end ofthe elongate member 30 to exit the patient's body when the ligating banddispenser 40 is adjacent to the target site inside the body. In oneembodiment, the length of the elongate member 30 may match the length ofthe endoscopic tube 54, but the elongate member 30 may be longer orshorter.

The proximal end of the elongate member 30 is connected to an actuatorassembly 20. The pull line 32 exits the proximal end of the elongatemember 30 and is connected to the actuator assembly 20. Actuation of theactuator assembly 20 operates to draw the pull line 32 in a proximaldirection. The actuator assembly 20 may comprise a means for useractuation of the actuator assembly 20 to draw the pull line. Theactuator assembly 20 may also comprise a means for drawing the pull linein a proximal direction. The means for drawing the pull line may alsoinclude a mechanism for preventing the pull line from moving in a distaldirection. In the embodiments shown herein, the actuator assemblyinclude a reel 26 on which the pull string is wound, and a pair ofbicycle brake type of handles 22. In operation, the user squeezes thehandles 22, causing a ratchet mechanism to rotate the reel 26 and drawthe pull line 32 by a desired length. The ratchet mechanism may bedesigned to permit the actuator assembly 20 to draw the pull line 32 ina proximal direction while preventing the pull line 32 from moving in adistal direction.

The means for user actuation is not limited to the handles in thedisclosed embodiments and may be any other type of mechanism foractuating the actuator assembly 20 to draw the pull line 32, includingmechanisms that use twist knobs, pistol grips and triggers, levers,slides, finger rings, or push buttons. Also, the means for useractuation is not limited to actuation by hand. Actuation may beperformed by other parts of the user's body. For example, the means foruser actuation may be a foot pedal. Also, the force used to actuate theactuator assembly is not limited to manual force. Actuation may also bemachine-driven or machine-assisted. For example, actuation may be drivenor assisted by springs, electric motors, or pressurized gas.

In certain embodiments, the means for user actuation may also beadjustable by the user. For example, where the means for actuation arehandles, the handle stroke may be adjusted to accommodate hand size oruser style or to allow for finer/coarser control. In another example,the means for actuation may include a mechanism for adjusting the amountof force needed to actuate the actuator assembly 20. The force may beadjusted using any conventional mechanism for creating resistanceincluding, for example, a spring mechanism or friction mechanism.

In certain embodiments, the actuator assembly 20 may also comprise amechanism, using friction for example, to allow the user to freeze oneor more components of the actuator assembly as actuation is occurring.Freezing one or more components of the actuator assembly may be used tohold the actuator assembly or the pull line in position. The actuatorassembly may also comprise a lock to prevent unintentional actuation.The actuator assembly may also comprise a mechanism for generatingaudible clicks to indicate that actuation is occurring or has occurred.

The means for drawing the pull line is not limited to the reel orratchet mechanisms of the embodiments shown herein. In otherembodiments, the means for drawing the pull line may be any other typeof mechanism that performs the function of drawing the pull line in aproximal direction and/or preventing the pull line from moving in adistal direction. Such other means for drawing the pull line may use anyconventional mechanism including those that employ cams or gears.

Also in the embodiment illustrated in FIG. 2, the actuator assembly 20includes an adaptor 28 allowing the actuator assembly to be attached toa flush port 52 of the endoscope. In the embodiments shown herein, theactuator assembly 20 includes a flush port 24 which has a lumencontinuous with the lumen of the flush port 52 on the endoscope. Inalternate embodiments, the proximal actuator assembly 20 may be attachedto another part of the endoscope 50. In other alternate embodiments, theproximal actuator assembly 20 may be free of any attachment to theendoscope. In any embodiment, the ligating instrument can be configuredto be operated by any person. For example, the ligating instrument maybe configured so that one person operates the endoscope while anotherperson operates the ligating instrument. In another example, theligating instrument may be configured so that the operator of theendoscope also operates the ligating instrument.

The actuator assembly 20 may be placed in various orientations orpositions in relation to the endoscope and are not limited to theorientations or positions of the embodiments shown herein. For example,the orientation of the handles 22 can be along any axis, such asperpendicular to the flush port 52.

In operation of the embodiment illustrated in FIG. 2, the user attachesthe ligating band dispenser 40 to the distal tip of an endoscope tube54. The user then unrolls the sleeve 60 to cover the distal end of theligating instrument 10 and endoscope tube 54. The user inserts theendoscope along with the attached distal end of the ligating instrument10 into the patient's body cavity, orifice, or lumen and positions theligating band dispenser 40 adjacent the target site. The proximal end ofthe ligating instrument 10 remains outside the patient's body. Todispense a ligating band, the user squeezes the actuator handles 22,causing the actuator to draw and ratchet the pull line 32. This drawingof the pull line 32 releases a ligating band from the ligating banddispenser.

The actuator assembly 20 may be calibrated such that a single actuationof the actuator pulls just enough pull line 32 to cause deployment ofone ligating band. Then, releasing the actuator sets the mechanism upfor the next deployment. Actuating the actuator again pulls just enoughpull line 32 to cause deployment of the next ligating band. In thismanner, the ligating bands are adapted to be deployed sequentially bysequential actuations of the actuator member.

In certain embodiments, any surface or part of sleeve 60, elongatemember 30, or pull line 32 may be coated with a lubricant or be formedof a low friction material. In certain embodiments, the ligatinginstrument may further comprise a counter indicating the number ofligating bands deployed or the number of ligating bands remaining. Incertain embodiments, the ligating instrument may further comprise anindicator, such as a gauge, that indicates that the next ligating bandis ready for deployment.

It will be appreciated that the embodiments as described and illustratedin FIGS. 1 through 7 have a number of advantages. First, because thepull line travels outside of the endoscope, there is no need to threadthe pull line through a lumen of the endoscope as with prior devices.Thus, setting-up the instrument for use is simplified. Second, the usercan mount the instrument onto the endoscope as a single functional unit.There is no need to tie or connect the pull line to the actuator orligating band dispenser. This also avoids the need to adjust the lengthof or tension on the pull line before or during use of the instrument.Third, the use of an elongate member through which the pull line travelsestablishes a fixed length between the ligating band dispenser and theactuator member. In this way, the actuation of the device will not causethe ligating band dispenser and actuator member to move closer relativeto one another. Stated another way, the elongate member provides anopposing force allowing drawing of the pull line.

The foregoing embodiments are merely examples of embodiments within thescope of the invention. Other embodiments are possible that incorporateone or more of the features or advantages of the above-describedembodiments. This invention thus embraces other embodiments within thescope of the claims.

1. A ligating instrument for deploying ligating bands inside the bodycomprising: (a) a ligating band dispenser comprising a support structureand at least one ligating band positioned on the support structure; (b)a pull line extending from the ligating band dispenser and adapted to bepulled for deploying said at least one ligating band off of the supportstructure; and (c) an actuator member adapted to pull the pull line tocause deployment of said at least one ligating band off of the supportstructure; wherein said ligating instrument further comprises anelongate member having a lumen, the elongate member extending from theactuator member to the ligating band dispenser; and wherein the pullline extends through the lumen of the elongate member with a proximalend of the pull line connected to the actuator member and a distal endof the pull line connected to the ligating band dispenser, whereinactuation of the actuator member draws the pull line in a proximaldirection through the elongate member to deploy said at least oneligating band off of the support structure.
 2. The ligating instrumentof claim 1, wherein the ligating band dispenser is adapted to be mountedon the distal tip of an endoscope.
 3. The ligating instrument of claim2, wherein the elongate member is adapted to be positioned outside ofthe endoscope from the ligating band dispenser to the actuator member.4. The ligating instrument of claim 3, further comprising a sleevepositioned on a distal portion of the ligating instrument, wherein thesleeve is adapted to be extended proximally to secure at least a portionof the elongate member relative to the outside of the endoscope.
 5. Theligating instrument of claim 4, wherein the sleeve comprises theelongate member.
 6. The ligating instrument of claim 4, wherein thesleeve comprises the pull line.
 7. The ligating instrument of claim 3,wherein the actuator member is adapted to be attached to the proximalend of the endoscope.
 8. The ligating instrument of claim 1, wherein theactuator member comprises a means for drawing the pull line.
 9. Theligating instrument of claim 8, wherein the means for drawing the pullline is a ratchet mechanism to draw the pull line in a proximaldirection while preventing the pull line from moving in a distaldirection.
 10. The ligating instrument of claim 1, wherein the actuatormember comprises a means for user actuation.
 11. The ligating instrumentof claim 10, wherein the means for user actuation is at least onehandle.
 12. The ligating instrument of claim 11, wherein squeezing thehandle actuates the actuator member to draw the pull line.
 13. Theligating instrument of claim 1, wherein a plurality of ligating bandsare positioned on the support structure of the ligating band dispenser,and wherein said ligating bands are adapted to be deployed sequentiallyby pulling the pull line.
 14. A ligating instrument for deployingligating bands inside the body comprising: (a) a ligating band dispensercomprising a support structure and at least one ligating band positionedon the support structure, wherein the ligating band dispenser is adaptedto be mounted on the distal tip of an endoscope; (b) a pull lineextending from the ligating band dispenser and adapted to be pulled fordeploying said at least one ligating band off of the support structure;and (c) an actuator member adapted to pull the pull line to causedeployment of said at least one ligating band off of the supportstructure; wherein the pull line is adapted to be positioned outside ofthe endoscope from the ligating band dispenser to the actuator member, aproximal end of the pull line being connected to the actuator member anda distal end of the pull line being connected to the ligating banddispenser, wherein actuation of the actuator member draws the pull linein a proximal direction to deploy said at least one ligating band. 15.The ligating instrument of claim 14, further comprising a sleevepositioned on a distal portion of the ligating instrument, wherein thesleeve is adapted to be extended proximally to secure at least a portionof the pull line relative to the outside of the endoscope.
 16. Theligating instrument of claim 15, wherein the sleeve comprises the pullline.
 17. The ligating instrument of claim 14, wherein said ligatinginstrument further comprises an elongate member having a lumen, theelongate member extending from the actuator member to the ligating banddispenser, wherein the pull line extends through the lumen of theelongate member.
 18. The ligating instrument of claim 17, wherein theelongate member is adapted to be positioned outside of the endoscopefrom the ligating band dispenser to the actuator member.
 19. Theligating instrument of claim 18, further comprising a sleeve positionedon a distal portion of the ligating instrument, wherein the sleeve isadapted to be extended proximally to secure at least a portion of theelongate member relative to the outside of the endoscope.
 20. Theligating instrument of claim 19, wherein the sleeve comprises theelongate member.
 21. The ligating instrument of claim 14, wherein theactuator member is adapted to be attached to the proximal end of theendoscope.
 22. The ligating instrument of claim 14, wherein the actuatormember comprises a means for drawing the pull line.
 23. The ligatinginstrument of claim 22, wherein the means for drawing the pull line is aratchet mechanism to draw the pull line in a proximal direction whilepreventing the pull line from moving in a distal direction.
 24. Theligating instrument of claim 14, wherein the actuator member comprises ameans for user actuation.
 25. The ligating instrument of claim 24,wherein the means for user actuation is at least one handle.
 26. Theligating instrument of claim 25, wherein squeezing the handle actuatesthe actuator member to draw the pull line.
 27. The ligating instrumentof claim 14, wherein a plurality of ligating bands are positioned on thesupport structure of the ligating band dispenser, and wherein saidligating bands are adapted to be deployed sequentially by pulling thepull line.
 28. A method of using a ligating instrument with anendoscope, comprising the steps of: (a) providing a ligating instrumentcomprising: (i) a distal ligating band dispenser having at least oneligating band adapted to be deployed by a pull line; (ii) a pull lineextending from the distal ligating band dispenser for deploying the atleast one ligating band; and (iii) a proximal actuator member coupled toa proximal end of the pull line, wherein actuation of the proximalactuator member draws the pull line in a proximal direction to deploythe at least one ligating band; (b) attaching the distal ligating banddispenser to a distal tip of an endoscope; and (c) extending the pullline on the outside of the endoscope, such that the pull line extends,on the outside of the endoscope, from the distal ligating band dispenserto the proximal actuator member.
 29. The method of using a ligatinginstrument with an endoscope as recited in claim 28, further comprisingthe step of extending a sleeve to secure at least a portion of the pullline relative to the outside of the endoscope.
 30. The method of using aligating instrument with an endoscope as recited in claim 29, whereinthe sleeve comprises the pull line.
 31. The method of using a ligatinginstrument with an endoscope as recited in claim 28, wherein theligating instrument further comprises an elongate member having a lumen,the elongate member extending from the actuator member to the ligatingband dispenser, wherein the pull line extends through the lumen of theelongate member.
 32. The method of using a ligating instrument with anendoscope as recited in claim 31, wherein the elongate member is adaptedto be positioned outside of the endoscope from the ligating banddispenser to the actuator member.
 33. The method of using a ligatinginstrument with an endoscope as recited in claim 32, further comprisingthe step of extending a sleeve to secure at least a portion of theelongate member relative to the outside of the endoscope.
 34. The methodof using a ligating instrument with an endoscope as recited in claim 33,wherein the sleeve comprises the elongate member.
 35. The method ofusing a ligating instrument with an endoscope as recited in claim 28,further comprising the step of attaching the actuator member to theproximal end of the endoscope.
 36. The method of using a ligatinginstrument with an endoscope as recited in claim 28, wherein theactuator member comprises a means for drawing the pull line.
 37. Themethod of using a ligating instrument with an endoscope as recited inclaim 36, wherein the means for drawing the pull line is a ratchetmechanism to draw the pull line in a proximal direction while preventingthe pull line from moving in a distal direction.
 38. The method of usinga ligating instrument with an endoscope as recited in claim 28, whereinthe actuator member comprises a means for user actuation.
 39. The methodof using a ligating instrument with an endoscope as recited in claim 38,wherein the means for user actuation is at least one handle.
 40. Themethod of using a ligating instrument with an endoscope as recited inclaim 39, further comprising squeezing the handle to actuate theactuator member.
 41. The method of using a ligating instrument with anendoscope as recited in claim 28, wherein a plurality of ligating bandsare positioned on the support structure of the ligating band dispenser,and wherein said ligating bands are adapted to be deployed sequentiallyby pulling the pull line.